Abstract
BackgroundThe shortage in human resources for health affects most dramatically developing countries which frequently use community health workers (CHW) as the basis for health programmes and services. The traditional definition refers CHWs as members of the community who are recruited and trained in health prevention and promotion to provide services within their community. In Guinea-Bissau, CHWs play a fundamental role in the diagnosis and treatment of childhood diarrheal diseases - one of the main health problems in the country.MethodsThis study is based on 22 CHW, 79% of the total number of CHW in the Sanitary Region of Bolama. The main goal was to assess how training CHW on diarrheal diseases impacted the accuracy of the diagnosis and treatment of these diseases in children under the age of 5 years. Three evaluations were made throughout time - one evaluation before the training and two follow-up evaluations.An observation grid was developed to evaluate the identified signs, symptoms, diagnosis and treatments prescribed by the CHW in consultations to children with a suspicion of diarrhoeal disease. A similar grid was filled by a medical doctor who took the role of the external validation standard.Friedman’s variance analysis and Cochran’s Q test were performed to compare the accuracy depicted by CHWs in identifying items throughout time. A logistic regression model was also used to check the possible influence of socio-demographic characteristics of CHWs on the accuracy of the diagnosis and treatment prescribed by the CHW.ResultsThe results show that CHWs improve significantly their performance in identifying the correct diagnosis in the first follow-up moment after the training (P = 0.001, n = 22) but, 3 months later, the effectiveness decreases. No statistical evidence was found for the logistic regression models applied.This progressive loss of performance after training may occur because CHWs fail to apply treatment algorithms and guidelines over time.A limited set of socio-demographic characteristics of the CHWs can influence their performance and should not be disregarded when selecting CHW candidates.ConclusionThe selection, supervision, support and continuous training of CHW are as important as the training provided.
Highlights
The shortage in human resources for health affects most dramatically developing countries which frequently use community health workers (CHW) as the basis for health programmes and services
This study aims to evaluate the short-term impact of training in the CHWs’ performance on diagnosing and treating diarrheal diseases in children aged under 5 years, and the evolution on diagnosis accuracy at 1 and 3 months after training
Data collection We considered the training provided to CHWs as the independent variable, while the measured dependent variable was defined as diagnosis and treatment accuracy (DTA)
Summary
The shortage in human resources for health affects most dramatically developing countries which frequently use community health workers (CHW) as the basis for health programmes and services. Health technologies and human resources tend to be concentrated in urban centres, people living in poorer and rural areas tend to have less access to health care, despite their greater needs [5]. As human resources are even less available in remote rural areas, many health programmes in low-income countries started to use community health workers (CHW) as providers of health services. These CHWs are members of the community who are recruited and trained in health prevention and promotion to provide services within their community [6]. CHWs represent an important group among health workers in low-income countries; in Africa, they comprise almost one-third of the total health workforce [5]
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